Provider Demographics
NPI:1649439241
Name:MARTIN, CYNTHIA (OD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 HERRING ROAD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:719-660-2162
Mailing Address - Fax:
Practice Address - Street 1:388 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1713
Practice Address - Country:US
Practice Address - Phone:719-391-2000
Practice Address - Fax:844-273-2910
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06002242Medicaid
CODP9041Medicare PIN
COCO307623Medicare PIN
COP00822266Medicare PIN